Key result
Medical management with anticoagulation successfully treated a young male patient with concurrent myocardial and cerebral infarction due to aortic mural thrombus, allowing discharge without disability.
Why the study?
Aortic mural thrombus is a rare acute aortic syndrome lacking guidelines or randomized evidence to guide therapy, and simultaneous cardiac and cerebral embolism is a particularly unusual presentation.
Case Report (n=1)
This case highlights the importance of careful clinical assessment and multimodality imaging in diagnosing acute aortic syndromes presenting with concurrent myocardial and cerebral infarction, and demonstrates successful medical management with anticoagulation.
Supports anticoagulation in select aortic mural thrombus cases with dual emboli; hypothesis-generating and should not yet change practice.
Background: Aortic mural thrombus is a rare acute aortic syndrome that can present with embolism to a distal organ. No guidelines or randomized evidence exist to guide therapy for patients with aortic mural thrombus. Cardiac and cerebral embolism is a particularly unusual presentation of aortic thrombus but has significant implications for patient management. Case summary: We present an unusual case of a young patient with simultaneous embolization of aortic thrombus to the coronary and cerebral vasculature, causing cerebral infarcts and a myocardial infarction. He presented with chest pain, slurred speech, right homonymous hemianopia, and inferior ST-elevation on electrocardiogram (ECG). Bedside echocardiography identified an inferoseptal regional wall motion abnormality. Emergent computerised tomography (CT) brain and aorta showed acute cerebral infarcts and aortic mural thrombus. He was managed medically with anticoagulation and discharged without disability after a period of rehabilitation. Discussion: This case demonstrates the value of careful clinical assessment in the setting of ST-elevation prior to transferring a patient for invasive angiography, as well as highlighting the role of echocardiography and CT imaging in the diagnosis of acute aortic syndromes. We describe the various management options for aortic mural thrombus, the role of multi-disciplinary decision-making, and our rationale for selecting a strategy of anticoagulation.
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Thurston et al. (2023) conducted a case report in Aortic mural thrombus with concurrent myocardial and cerebral infarction (n=1). Anticoagulation was evaluated on Clinical recovery. Medical management with anticoagulation successfully treated a young male patient with concurrent myocardial and cerebral infarction due to aortic mural thrombus, allowing discharge without disability.
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